<form id="edit-form" class="form-horizontal form-ajax" role="form" data-toggle="validator" method="POST" action="">
    <input type="hidden"  id="id" name="row[id]" value="{$row.id}">
    <div class="form-group">
        <label  class="control-label col-xs-12 col-sm-2">所属医生:</label>
        <div class="col-xs-12 col-sm-4">
            <input type="text" class="form-control" id="doctorname" name="row[doctorname]" value="{$row.doctorname}" disabled/>
        </div>
    </div>
    <div class="form-group">
        <label  class="control-label col-xs-12 col-sm-2">预约人编号:</label>
        <div class="col-xs-12 col-sm-4">
            <input type="text" class="form-control" id="r_ordersn" name="row[r_ordersn]" value="{$row.r_ordersn}" disabled/>
        </div>
    </div>
    <div class="form-group">
        <label  class="control-label col-xs-12 col-sm-2">预约人姓名:</label>
        <div class="col-xs-12 col-sm-4">
            <input type="text" class="form-control" id="username" name="row[username]" value="{$row.username}" disabled/>
        </div>
    </div>
    <div class="form-group">
        <label  class="control-label col-xs-12 col-sm-2">预约人电话:</label>
        <div class="col-xs-12 col-sm-4">
            <input type="text" class="form-control" id="phone" name="row[phone]" value="{$row.phone}" disabled/>
        </div>
    </div>
    <div class="form-group">
        <label  class="control-label col-xs-12 col-sm-2">预约人数:</label>
        <div class="col-xs-12 col-sm-4">
            <input type="text" class="form-control" id="re_num" name="row[re_num]" value="{$row.re_num}" disabled/>
        </div>
    </div>
    <div class="form-group">
        <label  class="control-label col-xs-12 col-sm-2">预约时间:</label>
        <div class="col-xs-12 col-sm-4">
            <input type="text" class="form-control" id="restime" name="row[restime]" value="{$row.restime}" disabled/>
        </div>
        <div>如：09:00-10:00，08:00-09:00</div>
    </div>

    <div class="form-group">
        <label  class="control-label col-xs-12 col-sm-2">预约金额:</label>
        <div class="col-xs-12 col-sm-4">
            <input type="text" class="form-control" id="price" name="row[price]" value="{$row.price}" disabled/>
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">排序:</label>
        <div class="col-xs-12 col-sm-4">
            <input type="text" class="form-control" id="sort" name="row[sort]" value=""  />
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">状态:</label>
        <div class="col-xs-12 col-sm-4">
            {:build_radios('row[status]', ['1'=>'待支付', '2'=>'预约成功','3'=>'结束预约','4'=>'取消预约'], $row['status'])}
        </div>
    </div>
    <div class="form-group hidden layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">确定</button>
            <button type="reset" class="btn btn-default btn-embossed">重置</button>
        </div>
    </div>
</form>